CSA Preparation Dr Omar Makki GP ST3

Why this presentation My dear colleagues, I felt that it is my duty to share with you some of the things that have helped me prepare and pass the CSA, in hopes that it might prove to be helpful to you all. Presentation by Dr Omar Makki - Dec 2011

Your daily surgeries You get really tired after the first few cases in the CSA, so getting used to doing your surgeries with no breaks is helpful Use 15 minute slots (10 for the consultations and 5 for QoF / Prescription / Documentation) Use a stopwatch to time your 10 minutes, this helps to develop a consistent and steady pace Try to wear the clothes you are planning to wear for the exam to see if they are comfortable enough for a 3 hour surgery, the last thing you want to be worried about during the exam is uncomfortable or inconvenient clothes Presentation by Dr Omar Makki - Dec 2011

Your consultations In each consultation you HAVE TO document the following: Ideas : e.g thinks headache is due to high BP Concerns : e.g worried it could be a tumour Impact : e.g not performing well in exams Expectations : e.g a brain scan Impression : e.g Tension Type Headache Options : e.g will try Paracetamol and relaxation, not keen on SSRIs Follow up : e.g Review in 4- 6 weeks Presentation by Dr Omar Makki - Dec 2011

The night before the exam Go with somebody who will support you (like your family), or somebody pleasant who can ease the pressure (like Nadeem “ Thank you Nadeem ”) Review the common criteria for 2WW Role play the “short/two-line” explanation of common conditions – e.g. You have overactive or irritable bowels, its common, it’s a life long problem, related to diet, lifestyle and stress and managing any of these brings about better control of symptoms Have a good night’s sleep and a very good breakfast (trust me, you’re going to need it) Presentation by Dr Omar Makki - Dec 2011

The exam - 1 Open the door for the patient, shake their hand, offer them a seat, and introduce yourself properly - e.g. “Hello Mr Smith, I’m Dr Brown, please come in and have a seat” The first 10 seconds are very important, its where they get their first impression, so smile, smile, smile.. and smile When stuck always try to ask the patient about what they think is the problem/solution, they will help you if you are doing things the right “sensitive” way. In addition to the case itself, each station is testing something additional, so be aware and try to find out what that thing is and use it for your benefit – e.g. 2ry nocturnal enuresis ?Differential Diagnosis, or patient with TIA ?Safe Doctor, or patient in a stressful situation ?empathy Presentation by Dr Omar Makki - Dec 2011

The Exam - 2 Sometimes you need to dig deeper to get the ICE hidden beneath the surface – so they might say the concern is having a brain tumour but the real concern might be that they are going to fail their exams – so please don’t just take it at face value, BE CURIOUS When you want to examine the patient, explain what you want to examine – e.g I want to have a feel of you abdomen and examine your pulse and blood pressure Remember when examining – this is an MRCGP exam not and MRCP one + this is not a real patient - maximum 2 minutes When explaining – keep it short and simple (KISS) – again don’t go into MRCP mode – this is an MRCGP exam so don’t go into details as you will lose the patient (and valuable minutes) Presentation by Dr Omar Makki - Dec 2011

The Exam - 3 When discussing the management plan, always offer options and allow patients to choose, they might ask you to recommend an option (you get marks for offering the choice not for giving too many options) – forget that you are a doctor and behave just like a waiter in a restaurant “you can have the steak or the chicken, and I would recommend our chicken as its very popular” The RCGP working group of 1972 described the future GP and outlined two characteristics that this future GP should never have – Arrogance and Lack of Empathy – when we are being doctor-centred it comes across as being arrogant, and when we are too clinical (and not friendly) it comes across as not showing empathy. Keep the patient talking and when they stop prompt them again to get them talking again – the more they talk the more you score. Presentation by Dr Omar Makki - Dec 2011

Thanks I would like to express my gratitude to my trainer Dr Anne Spalding for her expert advice and guidance – these tips are mostly extracted from her remarks during our teaching sessions I would also like to thank the North Lincolnshire GP VTS Organiser Dr Pat Webster and Directors Dr Meiwald, Dr Singh, Dr Maliyil, and Dr Qureshi, and my Educational Supervisor Dr John for the relentless efforts throughout the past three years. I would also like to thank Sree, Sean and Dr Allamsetty for their spectacular support during the build up to the exam. And.. I would like to wish all my colleagues and friends the best of luck for their exams.. I am sure that you will all pass confidently. OMAR Presentation by Dr Omar Makki - Dec 2011